- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.02 / $1,295.00 / $3,992.06
| Facility | | $242.02 | $1,295.00 | $3,992.06 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $75.75 / $138.00 / $303.85
| Facility | 52 | $75.75 | $138.00 | $303.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.20 / $795.20 / $795.20
| Facility | | $795.20 | $795.20 | $795.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.48 / $819.48 / $1,834.78
| Facility | | $819.48 | $819.48 | $1,834.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.00 / $1,305.00 / $3,046.00
| Facility | | $610.00 | $1,305.00 | $3,046.00 |